What should I discuss with my health care provider before using estradiol vaginal (systemic) (Femring)?

You should not use this medication if you are allergic to estradiol, if you are pregnant, or if you have:

liver disease;

a bleeding or blood-clotting disorder;

a history of heart attack, stroke, or blood clot;

unusual vaginal bleeding that a doctor has not checked; or

any type of breast, uterine, or hormone-dependent cancer.

To make sure estradiol is safe for you, tell your doctor about your other medical conditions, especially:

heart disease;

risk factors for coronary artery disease (such as diabetes, smoking, being overweight, having high blood pressure or high cholesterol, having a family history of coronary artery disease);

hereditary angioedema (an immune system disorder);

a history of jaundice caused by pregnancy or birth control pills;

a thyroid disorder;

kidney disease;

asthma;

epilepsy or other seizure disorder;

migraines;

endometriosis or uterine fibroid tumors;

lupus;

gallbladder disease; or

high levels of calcium in your blood.

Estradiol may increase your risk of developing a condition that may lead to uterine cancer. Your doctor may prescribe a progestin to take while you are using estradiol, to help lower this risk. Report any unusual vaginal bleeding right away.

Long-term use of estradiol may increase your risk of breast cancer, heart attack, stroke, or blood clot. Talk with your doctor about your individual risks before using estradiol vaginal long term.

FDA pregnancy category X. This medication can harm an unborn baby or cause birth defects. Do not use estradiol if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication.

The estradiol vaginal ring does not prevent pregnancy and should not be used in place of effective birth control.

Estradiol can pass into breast milk and may harm a nursing baby. This medication may also slow breast milk production. Do not use if you are breast-feeding a baby.

How should I use estradiol vaginal (systemic) (Femring)?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Wash your hands before and after inserting the vaginal ring.

You should not be able to feel the vaginal ring once it is in place. Leave the vaginal ring in place for 90 days, then remove it. Your doctor may want you to replace it with a new ring. The ring does not need to be removed during sexual intercourse. If the ring is bothersome, you may remove it, rinse it with warm water, and reinsert it after intercourse.

To remove the ring, loop a finger through the ring and gently pull it from the vagina. Call your doctor if you have trouble removing a vaginal ring.

Your doctor should check your progress on a regular basis (every 3 to 6 months) to determine whether you should continue this treatment. Self-examine your breasts for lumps on a monthly basis while using estradiol vaginal.

If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medication for a short time. Any doctor or surgeon who treats you should know that you are using estradiol.

Keep the vaginal ring in its protective pouch until you are ready to use it. Store at room temperature away from moisture and heat.